Instrumental vaginal delivery: a dying saving art; an experience at Dodoma Regional Hospital Tanzania

Abstract

The complications of prolonged and obstructed labor cause 4-13% of all maternal deaths in developing countries. This results other problems of women like obstetric fistula, Ruptured uterus and obstetric palsy. The
use of vacuum assisted vaginal deliveries can reduce these mortalities as well as have impact on the increasing rates of caesarean sections. Information about instrumental vaginal deliveries was obtained from all staff working in the labor and antenatal wards at Dodoma regional Hospital. Both doctors and midwives were interviewed using a pre-tested
questionnaire. In this study a total of 36 service providers consisting
of 24 midwives and 12 doctors were surveyed while in the qualitative part four individuals were interviewed consisting of two doctors, one midwife and one client. Of the 12 interviewed doctors only 4 (28.6%) had ever used vacuum for deliveries where out of 24 interviewed midwives, only 8 (33.3%) had ever used vacuum for delivery. All of them self reported to have a theoretical knowledge on the use of vacuum but only 5 (35.7%) of the interviewed doctors said they had a practical training, while on the
midwives arm out of the 24 interviewed providers only 8 (33.3%) reported to have had a practical training in using vacuum. Out of all doctors only 21.4% agree with use of vacuum while even less midwives (16.7%) accept the use of vacuum. On in-depth interview mixed reports were obtained but generally most had a negative inclination towards the use of vacuum for assisting delivery in the second stage of labor. Operative vaginal delivery is a dying life saving procedure that needs to be revived with clear explanation so as to change the negative perception towards its use and help to avoid un-necessary cesarean deliveries.

KEYWORDS: Vacuum, Delivery, Dodoma